Both simple decompression and anterior transposition of the elbow nerve (ulnar nerve) for acute displaced fractures of the elbow (distal humerus) treated with plate fixation are currently used by surgeons. We want to examine which treatment will overall give better results in regards to arm function and residual pain.

The primary outcome will be signs of ulnar neuropathy, measured using two clinical staging systems to assess the degree of dysfunction of the ulnar nerve (the classification system of Gabel and Amadio13). [ Time Frame: 1 Year ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Secondary outcome measurement will include a patient-oriented, limb-specific, functional measurement questionnaire (Disabilities of the Arm, Shoulder and Hand Instrument-DASH) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]

Fracture fixation will be performed through a posterior approach, as this provides excellent visualization of the distal fragments. A triceps split will be used to expose the distal humerus. A midline incision will be made from proximally to distal onto the shaft of the ulna. Equal portions of the triceps muscle will be reflected medially and laterally, with use of sharp dissection to remove the triceps insertion from the olecranon. The ulnar nerve will be identified and protected proximal and distal to the medial epicondyle. Fracture fixation will be performed after anatomic reduction using standard fixation techniques and plate fixation on both the medial and lateral column.

In the simple ulnar nerve decompression group, no further treatment of the ulnar nerve will be undertaken.

Active Comparator: anterior subcutaneous transposition

Procedure: anterior subcutaneous transposition

In the anterior transposition of the ulnar nerve group, the ulnar nerve will be placed subcutaneously anterior to the medial epicondyle free from any pressure.

Eligibility

Ages Eligible for Study:

16 Years to 60 Years

Genders Eligible for Study:

Both

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Men or women aged 16 to 60 years of age

Displaced, distal humerus fracture (OTA 13A or 13C) as seen in radiographs

Fractures ≤ 28 days post injury

Closed fractures

No history of previous ulnar neuropathy or elbow pathology

Provisin of informed consent

Exclusion Criteria:

Vascular injury

History of previous ulnar neuropathy or elbow pathology

Fractures more than 28 days post-injury

Limited life expectancy due to significant medical co-morbidity or medical contraindication to surgery

Inability to comply with rehabilitation or form completion

Likely problems, in the judgement of the investigators, with maintaining follow-up (i.e. patients with no fixed address, patients not mentally competent to give consent, etc.)

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01051869